Overcoming a dysfunctional relationship

Haywood Regional Medical Center, the entire medical community and its volunteer board of directors have some work to do. That is, they do if they want to protect the hospital’s competitive position in this region. Repairing the damage done by the controversy surrounding the firing of the emergency room physician group is vitally important.

Because I’m a journalist — and because I care about Haywood County — I’ve read all the stories in all the papers and most all the letters and columns about this episode, and I’ve had dozens of conversations with those involved in it and with members of the public. A very dysfunctional relationship exists between the appointed hospital board and the medical staff. That became apparent as this controversy unfolded, and fixing it is vital for this hospital’s reputation in the community.

Personalized health care

As I sit with my laptop and write this column at a local restaurant, a top hospital administrator and other hospital employees have just walked in and sat down a couple of tables away. That’s the reality of living in a small mountain community, and it’s also one of the reasons this particular situation created such a stir. Everyone knows everyone.

Like most, I have my own opinion about the dismissal last month of Haywood Emergency Physicians in a unanimous vote of the Haywood Regional Medical Center board. I have friends in HEP and know several hospital board members and hospital administrators. I also hold a glimmer of hope, small and unrealistic as it may be, that the firing will be reversed and HEP will be back, that some kind of mediation will occur.

Not much chance of that happening, I know. HEP was dismissed, and a corporate emergency room staffing entity is now under contract with HRMC.

Commenting on that — the firing itself — is not pertinent to the future. It is worth mentioning, though, during debate over HEP’s contract, much was made of bringing in a new group with a contract that met “the industry standard.” As a resident of Haywood County, I think I share a view similar to many others in saying that I don’t want industry standard health care. I want better.

One reason I live here is because it is a place filled with people who aren’t comfortable with many “standard” parts of American life. A lot of us don’t subscribe to the bigger is better mentality and we don’t like the movement away from person-to-person transactions, whether it’s in the retail sector or healthcare. I like being on a first-name basis with my kids’ teachers, the bank teller and the bank president, the jewelry counter person and the doctors I visit.

HRMC, of course, must meet its legal and contractual obligations to protect itself from lawsuits, but I hope the administration, the medical staff and especially the board truly work to achieve the hospital’s motto of “personalized, compassionate, quality healthcare.” People around here aren’t going to like doing business with a revolving door of emergency room physicians — or those in any other specialty area — instead of ones we know.

The board, medical staff

Here’s something you never hear or see in advertisements for hospitals or physician practices — “great health care at a great price.”

At first it seems a little absurd that health care is the single commodity in the United States where the price paid by the consumer has become irrelevant. Think again, though, and the idea of paying any amount of money for poor health care seems even more ridiculous. So what hospitals market is product — not price — and they usually do it in a way that tries to convey caring delivery of services in a professional, high-tech setting with the best doctors and specialists available. Integrity, a hard-to-quantify description that gives customers confidence, is everything.

That’s where the scenario that played out at HRMC last month could do the most damage. Customers, i.e., patients, may lose confidence. But it’s not just patients that could be scared off. As Dr. Henry Nathan pointed out in his speech to the hospital board the night HEP’s last appeal for mediaton was turned down, Haywood County’s ability to recruit talented physicians is already a tough sell. If Haywood County is also viewed as a place where the opinions and suggestions of the medical staff are routinely ignored, physician recruitment will be that much tougher in this era of doctor shortages. Being in the position of having to fight an uphill battle to lure both patients and doctors is not a good place to be.

Improving dialogue between the medical staff and the hospital board will only be accomplished if the doctors become more pro-active. The board has many other issues on its plate, but if the physicians want to have their voices heard — and their recommendations taken seriously — they are going to have to stay organized and make their opinions known.

Even though there are doctors on the hospital board, the problems in the relationship between the hospital board and the medical staff are obvious enough for even a casual observer to note: the two doctors on the board voted to terminate HEP’s contract, but the medical staff voted 50 to 2 to ask the board to seek mediation or arbitration to resolve the impasse, and the medical staff executive committee wrote a letter asking for the same. Four respected physicians spoke at the board meeting asking the board to reverse its decision.

Those facts show that the board feels one way, the great majority of the medical staff another.

In any community, front-line healthcare providers and hospital administrators often have different ideas about how things should be run. Those differences can lead to a beneficial tension that pushes the quality and delivery of health care to a better place. Or, the tension leads downward, to a dysfunctional relationship where administrators and physicians are competitors rather than colleagues.

The expertise of an engaged board is what can provide a balance in this situation. If the scales tip too far either way, and the hospital’s financial health suffers, the community as a whole is the loser.